A client with post-concussive syndrome recently reminded us of the dramatic way that employer-designated medical providers treat workers’ compensation patients differently from the way private medical providers treat patients. At each visit after the first one, the panel neurologist asked her to tell him what areas had improved, which he duly noted in his records. However, he didn’t ask her any other questions pertaining to her symptoms. For example, if she still had photophobia but her headaches were somewhat better, all the office note would say is that her headaches were better. As a result of his omission, to read the doctor’s office note you would think that the other symptoms didn’t exist. While the office note was accurate, it was dishonest because of being incomplete.
Similarly, in employer-designated physical therapy centers, physical therapists push patients to report improvement even when they are not getting significantly better. "Come on, you must be feeling a little bit better,” is a typical declaration injured workers get at physical therapy centers they have been referred to by company doctors. If their backs are in spasm, a serious sign of injury, these facilities often report “tightness” or “tenderness to palpation.” Company doctors know that injured workers only have an obligation to treat with them for a period of 90 days and often report significant improvement during that time, even when there has been little or none. When patient treatment reaches about the 70th day, many company doctors suddenly begin to describe “pre-existing conditions” as the cause of the patient's symptoms, knowing that the patient will not treat with them for longer than 90 days.
There are some very fine medical providers who treat patients at the request of insurance companies or employers. There is no reason, however, why patients should wonder whether the provider’s loyalties are to the insurance company or to them. For this reason, those who have suffered serious work injuries should almost always try to get documentation of their symptoms by a primary care physician even during the 90‑day period during which they are supposed to be treating with the company doctor. Furthermore, when the company 90 day treatment period expires, it’s time to get treated by someone you are sure is honest.